Download new patient forms
Please print new patient forms below and complete them prior to your first visit to PhysioTherapy Professionals. These forms include demographic data, insurance information, general patient history and description of payment policy that must be signed prior to treatment. If you have written documentation of past medical history or medication, we can copy this at the office for your convenience.
- Patient Summary Form and Health Questionnaire
- Consent to treatment form
- Authorization for Release of Medical Information
You will need the Adobe Acrobat Reader to view and print these forms.
Should you wish to fax completed forms to the office prior to visit, the fax number is 217-546-3302.
Accepted Insurance Providers
- Blue Cross / Blue Shield PPO
- Health Alliance
- Healthlink HMO/PPO
- Medicare Part B
- Personal Care \ Coventry HMO and POS
- Liabillity/auto claims
- United Healthcare
- Worker's Compensation
- Others may be accepted, contact us to find out
Private pay options available, discounts available. For cash payments, please contact 217-546-3301
We do not warrant or represent that the information in this site is free from errors or omissions or is suitable for your intended use. We recommend that you seek individual advice before acting on any information in this site. We have made every effort to ensure that the information on our website is correct at the time of publication but recommend that you exercise your own skill and care with respect to its use. If you wish to purchase our services, please do not rely solely on the information in this website.